Competition license application form
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- COMPETITION LICENSE APPLICATION FORM
- Attached Medical Form / Valid Driving License copy Insurance Personal Car with cover note form
A   utomobile Association of Tanzania
Kibasila/ Mathuradas Street Plot No. 670 Block No 34 P. O. Box 3004 Dar es Salaam Tanzania Tel: +255 22 2151837, 2152011, Fascimile: +255 22 2152011 e-mail: info@aatanzania.org web: www.aatanzania.org
COMPETITION LICENSE APPLICATION FORM ENTRANT AND/ OR DRIVER’S PARTICULAR Fees: PHOTO National Competition License Subscription Fee – T.Shs. 325,000/= Penalty if applied within seven days of the event – T.Shs. 50,000/=
SURNAME: _______________________________________________________________________________________ MIDDLE NAME: _______________________________________________________________________________________ FIRST NAME: _______________________________________________________________________________________ DATE OF BIRTH: __________________PLACE OF BIRTH _____________________ NATIONALITY__________________ P. O. BOX: ________________________________CITY __________________________________________________ TEL: ________________________________ EMAIL ________________________________________________ Driving License No:........................ Date of Issue: ........................ Place of Issue ...................................... Class.............................................. Date of Expiry:......................
Attached Medical Form/ Valid Driving License copy & Insurance Personal & Car with cover note form
A/c Details: - AUTOMOBILE ASSOCIATION OF TANZANIA (Diamond Trust Bank A/c Tshs. 0404750001) Plastic License will only be issued if payment/ and all other Documents are submitted in correct order. B C
E EEE C F lub Membership specify: ………………………………………………………………………………………………….. Club Name: ……………………………………………………………………………………………………………………… Position of Club official: ……………………………………………………….……………………………………….………. Signature of the Club official: ………………………………... Cell contact:……………………… Date: …………………. R Rubber stamp ubber stamp & Date: -------------------------------------- Signature of Applicant
Competition License No…………………………… Authorized signatory ……………………………… Download 130.34 Kb. Share with your friends:
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